We’re Here to Guide You

Purchasing health insurance on your own may be a new experience for you, so take your time.
Here are few things to consider:

1. Understand dates.

If you didn’t enrolled in a health insurance plan by January 31, 2017, you can only enroll in 2017 coverage if you have a qualifying life event such as getting married, having a child or losing employer coverage, for example. Otherwise, you will likely have to wait for the Open Enrollment Period for 2018 coverage. Open Enrollment Periods typically follow a yearly cycle.

If you do have a qualifying life event and are eligible for a Special Enrollment Period (SEP), you must enroll in a plan within 60 days of the triggering event.

Learn more about qualifying life events and Special Enrollment Period opportunities at Healthcare.gov.

It’s important to remember that you can still be eligible for financial help if you enroll during a Special Enrollment Period.

You’ll find plans from the Highmark brand of families when you shop on the Health Insurance Marketplace. You can purchase coverage through our website, through many local insurance agents, or by phone.

Need More Help?

As the costs of health care continue to rise, having coverage will help protect you against costly bills if you get sick or injured. Having coverage will also give you peace of mind.

Highmark offers many plan options for individuals and families looking for affordable coverage, without compromising on quality or access to the doctors and health service providers that matter most. Our plans consistently rank among the highest in member service and plan satisfaction.

2. Familiarize yourself with recent changes to health insurance Highmark can help you learn more about financial help, “metal level” plans, Essential Health Benefits, and other aspects of health care terminology.

If you’re a small business or group administrator shopping for plans, Highmark’s Business Resource Center has the answers you need.

3. Learn the basics of health insurance. Check out the “Insurance Terms You Should Know,” and “Tips For Choosing the Right Highmark Plan” before you shop.the exact coverage you have today may not be available in 2017, Highmark may still have a plan to fit your needs. Or, it’s possible that the plan with the best coverage for you may be found elsewhere on the Health Insurance Marketplace.

Tips for Choosing the Right Highmark Plan

  • It’s a good idea to choose a plan that covers services you think you’ll use frequently, even if it means paying a higher monthly premium, because it will likely save you money in the long run.

  • Don’t automatically choose a plan with a low monthly premium and a high annual deductible. Why? Because low monthly payments are tempting, but if you have a serious injury or illness, having to meet a high deductible before your insurance starts paying for your care can be difficult. Find a plan that has a deductible that you can actually meet without hardship.

  • Consider pairing qualified high-deductible plans with an HSA (Health Savings Account). HSAs allow you to use pre-tax income for health care expenses and can be used to pay your deductible. Account contributions are not taxed and funds in the account roll over. Consult your tax or financial advisor to learn more.

  • If you have a primary care physician or specialist that you want to continue to see, make sure they are in the plan’s network or that you can afford to pay more to see them if they are “out-of-network.”

  • The Affordable Care Act requires that all insurance plans include prescription drug coverage. The term “formulary” refers to a list of drugs your insurance plan covers. A drug’s formulary status may impact how much you pay for each drug. If you regularly take prescription medication, make sure that it is covered by the plan or that you can afford to pay more for it if it’s not covered.

  • Carefully consider copay and coinsurance rates for doctor visits, surgeries and prescriptions. Frequent copays and coinsurance payments can add up for brand name or specialty prescriptions and hospital care, even if you are staying in the network.

  • Thoroughly read and understand the coverage provided by the plans you are considering. Making the right decision now could save you time and money later.

By considering the information listed above, you’ll be able to choose a plan that gives you the coverage you need at a price you can afford.

Buying health insurance online in Delaware (DE), Pennsylvania (PA), and West Virginia (WV) is quick and easy, and we have resources to help you weigh cost, coverage, and network considerations.

Insurance Terms You Should Know

1. Premium

The dollar amount you pay for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

2. Office Visit Copayment (copay)

A fixed, upfront dollar amount (for example, $25) that you pay each time you receive certain health care services. The amount can vary based on the type of health care service you receive, such as filling a prescription drug, seeing your doctor or visiting a specialist. After paying your copay, your insurance company will usually pay the remainder of your bill for covered in-network care.

3. Deductible

The dollar amount you must pay each benefit period (usually a year) for your health care expenses before your plan begins to pay for covered in-network services. For example, if you have a $500 deductible, that’s the amount you will pay before your insurance plan will pay for covered in-network services. Copayments are not included.

4. Coinsurance

Your part of a medical bill that you pay after reaching your deductible. For example, if your medical bill for covered, in-network services is $100 and your coinsurance is 20%, you pay $20. The insurance company pays $80.

5. Maximum Out-of-Pocket (Out-of-Pocket Limit)

The highest amount you will need to pay each benefit period (usually a year) for covered in-network care before your insurance company pays 100%. For example, if your out-of-pocket maximum is $2000, once you have paid $2000 the insurance company pays for 100% of the plan allowance for covered in-network care. This does not include any services not covered by your plan.

6. PCP

A Primary Care Provider (PCP) is the medical professional who provides a patient’s care and helps them access a range of health services. This could be a doctor, nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law.

7. Network

Doctors, hospitals, clinics, labs, and other providers that a health insurer has contracted with to provide health care services to its members. You usually pay less when you use health care providers that are “in-network.” You may pay extra if you see a health care provider who is “out-of-network.”

8. Formulary

A list of drugs your insurance plan covers. A drug’s formulary status may impact how much you pay for each drug.

9. Health Savings Account (HSA)

A tax-exempt savings account you can set up with a financial advisor to save for potential future medical expenses.

10. Cost-sharing

The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance and copayments, or similar charges, but it doesn’t include premiums, balance billing amounts for non-network providers, or the cost of non-covered services.

11. Diagnostic Services

Lab work or tests ordered by a doctor or health care professional to learn more about a specific condition or disease. Examples include X-rays and blood tests.

12. Preventive Care

Screenings or routine services that may prevent or detect problems before they advance. For example, child wellness visits are preventive care.

13. Benefit Period

The specific period of time during which charges for covered services must be incurred in order to be eligible for payment by the health plan. A charge is considered incurred on the date a member receives a service or supply for which the charge is made.